(The Center Square) – On Wednesday, the Pennsylvania Homecare Association met in Camp Hill to celebrate the workers who give thousands of the state’s disabled and elderly population the gift of independence.
At the same time, leaders in Harrisburg voted in and celebrated an overdue budget, one that advocates say leaves the home care industry desperately underfunded.
“While you’re working on this budget, you’re leaving us out,” said Mia Haney, CEO of the Pennsylvania Homecare Association in a LinkedIn post addressed to Gov. Josh Shapiro and the General Assembly. “You have to remember that home care works.”
“Fund the front lines,” shouted a group of direct care workers behind Haney, gathered to be honored for their service while their livelihood remains among the political footballs being tossed at both state and national levels.
The new state budget infuses an additional $21 million into the home care industry, specifically for caregivers who work in the participant-directed model. For most home caregivers who work within agencies, the budget offers no change.
Flat-funding isn’t unusual, especially in a budget year where spending is under intense scrutiny and the state is facing a legal requirement to increase investments in education. What sticks out, however, is that this year the state released two separate studies investigating shortfalls in staffing and wages in the home care industry.
“This budget represents a devastating failure of leadership by Governor Shapiro, his Administration, and the General Assembly,” said Haney. “Pennsylvania’s legislature had the opportunity to address the state’s home care crisis but instead chose politics over people.
Instead of solving the problem, lawmakers approved funding for just 6% of workers – while abandoning the 94% of caregivers who deliver the overwhelming majority of care across the Commonwealth. This is not how you stabilize a collapsing system; this is how you deepen a crisis.”
Key to the home care crisis are Medicaid reimbursement rates, a figure set by the state. In Pennsylvania, the rate sits at $20.63, meaning that after overhead, most workers are taking home between $13 and $16 per hour. This figure sits well below every neighboring state, from Maryland’s $25.58 reimbursement to New York’s $36.31. West Virginia’s rate is now $26.96, up from about $19.
A study released in February by the Shapiro administration showed a 23% shortfall. Haney and other advocates didn’t expect to see that gap closed in a single budget season. Instead, they were hoping for a 10% increase and point to states like New Jersey who raise the rate incrementally, tying it to cost of living.
Workers say home care can be emotionally and physically exhausting compared to jobs in the retail and service industries that pay comparable, if not higher, wages. It’s difficult to recruit staff and even harder to retain it.
“I am in a position right now where I am faced with leaving the field,” said Monica McDuffie, a home care worker who testified before the Senate Democratic Policy committee Monday. “I would like to stay in home care, but it does not pay enough. I have children. I have bills, and so I have to make a hard decision, and that’s to do what I love or follow the money, and it’s a shame that that’s what it’s coming down to.”
McDuffie is in nursing school, pursuing a career that will allow her to earn more while caring for others, but the roles are hardly interchangeable. Home care workers offer personal assistance that allow people to maintain their independence living in their communities. When shifts are missed, those they care for may find themselves stuck in bed, missing meals, going without a bath, or skipping medications.
Financial analyses indicate that even when people need full-time care, the cost of direct care is far less than the old model, which required institutionalizing vulnerable populations to provide care. The association says that nursing homes on average cost about 127% more than home care. Nursing homes in the state run upwards of $10,000 per month, which can quickly drain families of savings.
At the PHA award ceremony Wednesday, Deputy Secretary of the Office of Long-Term Living Juliet Marsala said that the state had “moved the needle” from 25% to 78.3% of people receiving services in the community. She noted, however, that with federal threats to Medicaid, the progress made over the past 60 years was in danger.
“And so this is where everyone in this room continues to play such a crucial and critical role, not only in the day-to-day work that you do but also – and I hate to ask more of you – but to be educators of what the Medicaid program does, about the important values of your direct care worker profession as a healthcare professional and for the impact of those served for the impact to the health care system,” said Masala.
“The Medicaid program is essential to that support,” she continued. “It’s essential resources, and it deserves to be funded in order to fulfill the mission of providing care to the most vulnerable in our nation and also to supporting the direct care workers and professionals that are the backbone to that system.”
